Premenstrual syndrome

What is it?

Premenstrual syndrome (PMS) has a wide variety of symptoms, including mood swings, tender breasts, food cravings, fatigue, irritability and depression. An estimated 3 of every 4 menstruating women experience some form of premenstrual syndrome. These problems tend to peak in your late 20s and early 30s.

Symptoms tend to recur in a predictable pattern. Yet the physical and emotional changes you experience with premenstrual syndrome may be particularly intense in some months and only slightly noticeable in others.

Still, you don't have to let these problems control your life. Treatments and lifestyle adjustments can help you reduce or manage the signs and symptoms of premenstrual syndrome.

Symptoms

The most common signs and symptoms associated with premenstrual syndrome include:

Physical signs and symptoms

Although the list of potential signs and symptoms is long, most women with premenstrual syndrome experience only a few of these problems.

For some women, the physical pain and emotional stress are severe enough to affect their daily routines and activities. For most of these women, signs and symptoms disappear as the menstrual period begins.

But a few women with premenstrual syndrome have disabling symptoms every month. This form of PMS has its own psychiatric designation — premenstrual dysphoric disorder (PMDD). PMDD is a severe form of premenstrual syndrome with signs and symptoms including severe depression, feelings of hopelessness, anger, anxiety, low self-esteem, difficulty concentrating, irritability and tension. A number of women with severe PMS may have an underlying psychiatric disorder.

Causes

Exactly what causes premenstrual syndrome is unknown, but several factors may contribute to the condition:

Cyclic changes in hormones. Signs and symptoms of premenstrual syndrome change with hormonal fluctuations and disappear with pregnancy and menopause.

Chemical changes in the brain. Fluctuations of serotonin, a brain chemical (neurotransmitter) that is thought to play a crucial role in mood states, could trigger PMS symptoms. Insufficient amounts of serotonin may contribute to premenstrual depression, as well as to fatigue, food cravings and sleep problems.

Depression. Some women with severe premenstrual syndrome have undiagnosed depression, though depression alone does not cause all of the symptoms.

Stress. Stress can aggravate some of your PMS symptoms.

Poor eating habits. Some PMS symptoms have been linked to low levels of vitamins and minerals. Other possible contributors to PMS include eating a lot of salty foods, which may cause fluid retention, and drinking alcohol and caffeinated beverages, which may cause mood and energy level disturbances.

Diagnosis

There are no unique physical findings or laboratory tests to positively diagnose premenstrual syndrome. Your doctor may attribute a particular symptom to PMS if it's part of your predictable premenstrual pattern. To help establish a premenstrual pattern, your doctor may have you:

Keep a diary. Record your signs and symptoms on a calendar or in a diary for at least two menstrual cycles. Note the day that you first notice PMS symptoms, as well as the day they disappear. Also be sure to mark the day your period starts and ends.

Fill out a questionnaire. On the first day of your period, you fill out a questionnaire. The questions pertain to any PMS symptoms you experienced during the prior two weeks. This tool helps your doctor know whether you might benefit from further evaluation.